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242. Complications of Airway Devices

Tube Change: Do not try to change if < 7 days old due to possible false passage creation. Do not need to rush the procedure. Stable patient can easily breath through the stoma. Use an obturator to minimize soft tissue damage though when placed, quickly remove the obturator. Lay patient supine when doing procedure. Can consider using suction catheter as a sort of bougie if needed. Inner cannula is in place (usually not on pediatric patients) to allow clearance of secretions. Cuffed tubes used if patient is usually placed on ventilator.

Tube Obstruction: suction within inner cannula. If unable to, remove inner cannula checking for secretions and suction through outer cannula. If still having difficulty, use sterile saline with suction. Always try to preoxygenate before doing so.

Tracheostomy Site Bleeding: could be due to granulation tissue, thyroid vessel erosion, the trachea wall, or the innominate artery. Slow local bleeding can be controlled with silver nitrate. If heavy bleeding, place cuffed tube below site of bleeding.

Tracheoinnominate artery fistula: due to pressure against artery causing erosion or from overinflation of the cuff. Usually in first 3 weeks of trach (peak at 1-2nd week). 50% will present with sentinel arterial bleed or hemoptysis. If massive bleeding, need to hyperinflate the cuff. If that doesn’t work, consider passing ETT past area of bleeding and then holding direct digital pressure against manubrium of the sternum until able to take to OR.

Tracheal Stenosis: usually due to scarring. can be seen on xray. temporizing treatment includes humidified oxygen, racemic epi, steroids. ENT consult for rigid bronch and laser excision may be required.

Passy-Muir valve: one-way valve that fits over uncuffed trach tube and allows forced exhalation to obstruct trach causing air to go up to vocal cords. If having a problem with it, just remove the valve.

Tracheoesophageal prosthetic valve: placed valve in fistula created between trachea and esophagus so with forced exhalation can allow speaking. If opening is too large, can place foley temporarily. At increased risk for aspiration if fistula is too large.